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Vertebral fracture identification toolkit

Our vertebral fracture identification toolkit includes a set of clinical pathways and audit tools. These are designed to help you:

  • establish pathways for vertebral fracture patients
  • support quality improvement for vertebral fracture identification
  • predict how many vertebral fractures you should expect to see in your area
  • develop a business case to support better identification and management of vertebral fractures within fracture liaison services (FLS)

Clinical pathways

Use our clinical pathways to establish best practice care for vertebral fracture patients, from identification to secondary fracture prevention.

These pathways can be used if you don't have access to a FLS in your area. They define best practice secondary fracture prevention for Scotland, England, Wales and Northern Ireland:

This pathway can be used to support appropriate management for patients with newly-identified vertebral fractures who are referred from imaging departments:

 

These pathways can be used to support secondary fracture prevention in different scenarios.

Within FLS:

In the absence of FLS:

These pathways support decision making for the management of new vertebral fractures. They can be used to support quality improvement programmes in vertebral fracture identification:

Audit tools

Use our audit tools to understand how well your service is identifying vertebral fractures and find opportunities for quality improvement. 

These can be used as part of routine clinical audit and quality improvement cycles, and can be adapted for your department's needs.

Audit tool for CT scans

This tool helps to evaluate the identification of opportunistic vertebral fractures via CT scans.

This tool includes:

  • audit criteria
  • data collection sheet
  • audit reporting template
  • definitions of a vertebral fracture

To use this tool, you'll need to be confident in assessing sagittal spine CT images to identify vertebral fractures, and have access to original clinical radiology reports.

Audit tool for referrals to DXA

This tool can help you to learn:

  • the proportion of referrals to your DXA service that indicate vertebral fractures
  • the referral source
  • whether there were previous missed opportunities to identify vertebral fractures

It includes:

  • audit criteria
  • data collection sheet
  • audit reporting template

This tool could inform a business case for service development (for example, the introduction of vertebral fracture assessment to a DXA service), and help you understand how DXA could drive demand for FLS as a previously unexplored pathway.

Audit tool for spine pathways

This tool is for evaluating the identification of vertebral fractures via spine pathways (for example, musculoskeletal or back pain services). It can help to establish whether these spine pathways may be a good place to identify vertebral fractures, and whether patients with vertebral fractures are being reported.

It includes:

  • audit criteria
  • data collection sheet
  • audit reporting template
  • definitions of a vertebral fracture

To use this tool, you'll need to be confident in assessing spinal imaging to identify vertebral fractures, and have access to original clinical radiology reports.

 

FLS demand model tool

This is a tool for predicting the increase in demand on your FLS if you begin searching for incidental vertebral fractures on imaging.

This tool can help to:

  • drive service improvement
  • inform a business case for service development
  • inform a business case for a new FLS, spinal service, or vertebral fracture FLS

It includes:

  • instructions for use
  • audit criteria
  • data collection sheet
  • reporting template for audit report and demand report
  • definition of a vertebral fracture
  • management pathway for secondary fracture prevention

To use this tool, you'll need to be confident in assessing sagittal spine CT images to identify vertebral fractures, and have access to original clinical radiology reports. You'll also need to know how many CT scans you complete in an average month or year.

  

Our toolkit is supported* by:

*Amgen has provided financial support for this work but has not inputted or influenced its development.